Short-term Outcomes After Upfront Chemotherapy Followed by Curative Surgery in Metastatic Colon Cancer: A Comparison With Upfront Surgery Patients

PURPOSE: Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.METHODS: Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.RESULTS: There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).CONCLUSION: There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.

Mirizzi Syndrome: A Single Center Experience

PURPOSE: Mirizzi syndrome is caused by extrinsic compression of the common hepatic duct by stones impacted in the cystic duct or the gallbladder neck. The standard treatment for Mirizzi syndrome has been open cholecystectomy. The aim of this study was to review our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: Data were collected retrospectively through chart review of 9,360 patients who underwent cholecystectomy between April 1983 and August 2016. RESULTS: Mirizzi syndrome was identified in 21 of 9,360 patients (0.22%). The mean age at diagnosis was 56 years. The most common symptom was abdominal pain (85.7%). A total of 16 patients (76.2%) were diagnosed with McSherry type I and 5 patients (23.8%) with McSherry type II. Laparoscopic cholecystectomy (LC) was initiated in 13 patients and open cholecystectomy (OC) in 8 patients. Conversion from LC to OC was reported for 3 patients (conversion rate 18.8%). In 4 patients with McSherry type II, an additional procedure (T tube insertion or hepaticojejunostomy) was required. CONCLUSION: Preoperative diagnosis of Mirizzi syndrome is very important in order to plan surgical strategy. LC is possible in selected patients with Mirizzi syndrome. However, OC is suitable in patients with McSherry type II. In the near future, laparoscopic procedures may be adaptable in patients with McSherry type II.